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Why do we have to have the TB jab before going onto tocilizumab?

Q) If my generation has already been inoculated against TB, why should we have to be inoculated again before going on tocilizumab for rheumatoid arthritis? Surely this is just an added expense for the NHS?
Mrs Andrews, Essex (Autumn 2012)

A) The new powerful biologic drugs may cause a recurrence of previous infection with TB. The problem with TB is that you can be infected without really knowing it and the body responds and ‘seals’ the infection off, but it hasn’t gone away. If you are then given powerful immunosuppressant drugs like TNF inhibitors and tocilizumab that defence is broken down and the TB can come back again – often with a vengeance.

So, everyone going onto these drugs has to be screened for latent TB (usually a chest x-ray and blood test, sometimes a skin test) and if screening indicates previous infection we usually recommend a short three-month course of anti-TB drugs before starting the new medication. Inoculation is used in people who have never had the disease in an attempt to induce immunity.

Most of us oldies had this at school but it is only used for at risk groups these days. However, at the point of starting drugs such as tociluzimab there is little point as what really matters is if you had it in the past.

This answer was provided by Dr Philip Helliwell for the Autumn 2012 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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